Clinical value of dual-energy computed tomography in identifying urinary calculi composition
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摘要: 目的 探讨Revolution单源双能CT对泌尿系结石成分定性诊断的影像价值。方法 选取2018年4月-2020年6月在我院接受治疗的泌尿系统结石患者, 收集不同部位结石共105枚, 患者均进行单源双能CT扫描, 并通过工作站进行结石成分分析, 测得70 Kev CT值、有效原子序数, 将影像分析结果与临床通过红外光谱法分析的结果进行比较, 分析单源双能CT对体内结石成分分析的准确性。各组比较采用单因素方差分析, 组间多重比较采用LSD法。结果 以临床红外光谱分析结果为标准, 单源双能CT应用碘水基物质图分析尿酸结石的准确率达99%, 应用有效原子序数这一指标分析非尿酸结石中草酸钙结石、混合结石的准确率分别为79%、87%。碘水基物质图像区分尿酸与非尿酸结石的灵敏度、特异度分别为100%、100%。结论 单源双能CT能有效诊断泌尿系结石成分, 为临床治疗方案提供有力依据。Abstract: Objective To explore the imaging value of Revolution dual-energy computed tomography (DECT) in the qualitative diagnosis of urinary calculi composition.Methods From April 2018 to June 2020, 105 patients with urinary calculi who were treated in our hospital were selected for DECT scanning and composition analysis using workstation. CT value and effective atomic number (Zeff) were measured at 70Kev, and the imaging results were compared with those obtained by clinical infrared spectroscopy to analyze the accuracy of DECT in the diagnosis of calculi composition. One-way analysis of variance was used for comparison between groups, and LSD method was used for multiple comparisons among groups.Results Based on the results of clinical infrared spectroscopy analysis, the accuracy of DECT in the analysis of uric acid stones using iodine water based substance image was 99%, and the accuracy of using the effective atomic number to analyze calcium oxalate stones and mixed stones in non-uric acid stones were 79% and 87%, respectively. The sensitivity and specificity for distinguishing uric acid and non-uric acid stones using iodine based substance image were 100% and 100%, respectively.Conclusion DECT can effectively diagnose the composition of urinary calculi and provide a favorable basis for clinical treatment plan.
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Key words:
- dual-energy CT /
- urinary calculi /
- effective atomic number /
- CT value
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表 1 CT影像与红外光谱的结石成分分析结果
枚(%) CT影像分析结果 红外光谱结果 阳性 阴性 尿酸 阳性 8(7.62) 0 阴性 1(0.95) 96(91.43) 草酸钙 阳性 45(42.86) 8(7.62) 阴性 14(13.33) 38(36.19) 磷酸氢钙 阳性 2(1.90) 5(4.76) 阴性 0 98(93.33) 磷酸镁铵 阳性 0 1(0.95) 阴性 2(1.90) 102(97.14) 胱氨酸 阳性 0 5(4.76) 阴性 0 100(95.24) 混合型 阳性 18(17.14) 13(12.38) 阴性 0 74(70.48) 
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表 2 CT诊断的灵敏度、特异度及准确率
% 诊断指标 影像结石分析结果 尿酸类 草酸钙 磷酸氢钙 混合 灵敏度 89 76 100 100 特异度 100 83 95 85 准确率 99 79 97 87
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表 4 CT值与Zeff值的诊断效能
X±S 结石成分 Zeff值 70 Kev下CT值/HU 单纯型结石 尿酸(8枚) 7.86±0.39 522.65±91.38 草酸钙(53枚) 12.91±1.591) 1215.66±282.90 磷酸氢钙(7枚) 13.34±0.941)2) 1213.82±381.16 胱氨酸(5枚) 11.71±0.611)2)3) 860.55±283.26 混合型结石 草酸钙/磷酸氢钙(21枚) 13.65±0.83 1363.16±287.34 胱氨酸/磷酸镁铵(6枚) 11.28±0.47 771.33±244.61 草酸钙/磷酸氢钙/胱氨酸(4枚) 13.36±0.58 1395.21±145.96 F 24.15 13.14 P值 < 0.001 < 0.001 与尿酸比较，1)P < 0.05；与草酸钙比较，2)P < 0.05；与磷酸氢钙比较，3)P < 0.05。
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